TEFCA Interoperability Framework to Enhance Health Data Exchange, Security

The Trusted Exchange Framework and the Common Agreement (TEFCA) interoperability framework is set to streamline health data exchange for enhanced care delivery.

ONC and its Recognized Coordinating Entity (RCE), The Sequoia Project, Inc., announced the publication of TEFCA in January 2022. The Trusted Exchange Framework is a set of non-binding but foundational health information exchange principles, while The Common Agreement establishes the technical infrastructure and governing approach to support data exchange between healthcare organizations.

Entities will soon be able to apply to be Qualified Health Information Networks (QHINs). These networks will connect to one another to support health information exchange nationwide.

“Interoperability is really creating that secure environment in which patients can get at the data that they want when they want it,” Lee Barrett, CEO & executive director of EHNAC, a health IT data standards accreditation organization, told EHRIntelligence in an interview.

Barrett has been working on the national interoperability framework since the first draft version of TEFCA came out in 2018.

Healthcare interoperability has long been a key goal for the industry, but coordinating the moving parts between payers, providers, pharmacies, labs, and other key players has posed a challenge, Barrett noted.

“There are so many different agreements that have to take place between these various entities to exchange data, and that causes a big bottleneck in relation to the amount of cost and the legal aspects that organizations have to deal with to set up these agreements,” Barrett said.

This general lack of interoperability has made access to patient health information difficult.

Barrett said that TEFCA will help providers access comprehensive EHR data in a timelier manner for improved care delivery.

For example, say a patient has a medical emergency while traveling out of state and they are unconscious. Physicians will do everything they possibly can for that patient, but there are limitations because providers do not have access to the patient’s EHR data for clinical decision support, Barrett explained.

Once TEFCA operationalizes, providers will have access to comprehensive patient EHR data no matter who the patient is, Barrett said.

“With TEFCA, if a patient is rolled into an emergency room unconscious, the provider can get the patient’s personal identification from their purse or wallet and key that information into an EHR system, which will then pull all of these QHINs to create and develop a comprehensive EHR on that patient,” he explained.

Barrett said that having complete EHR data will allow attending physicians to start treatment in a more holistic manner because they will understand the patient's background.

TEFCA is also set to “raise the bar” on data privacy and security to assure stakeholder and patient trust. This is critical today with so many cyberattacks, ransomware attacks, and HIPAA breaches, Barrett said.

Entities looking to become QHINs will need to demonstrate to the RCE that they have the capabilities to fulfill the common agreement.

“The problem today is all these various stakeholders have to have individual contracts between them,” Barrett said. “It's expensive and takes a lot of time to have all these various agreements. What TEFCA is going to do is now create one agreement, a common agreement, that all these QHINs will sign with the RCE.”

Barrett said that health information exchanges (HIEs) and health information networks (HINs) are potentially the best candidates to become a QHIN.

“Many of them are in a good position because they're already providing a lot of data aggregation capabilities and other metrics to the stakeholders that are part of their network,” he said.  

Barrett noted that the other aspect of TEFCA involves stakeholder participants. These healthcare organizations, such as health plans, hospital systems, labs, and pharmacies, will input and exchange data with QHINs.

“It's really going to be the QHINs interconnected amongst themselves from an interoperability perspective that really create this transparent network for patients,” Barrett explained.

TEFCA data exchange will occur through Fast Healthcare Interoperability Resource (FHIR) application program interfaces (APIs).

FHIR APIs will provide patients access to personal health information through portals. EHR vendors will also exchange data between themselves and with QHINs using FHIR APIs, Barrett said.

“That's what interoperability is looking to do between not only the QHINs, but all the participants and sub-participants as well,” Barrett said. “It really creates this data exchange capability and access for patients that are not there today.”

“We haven't been able to achieve interoperability to the level that we can with TEFCA going forward,” he emphasized. “We've had good successes on a variety of fronts as far as interoperability, but not anywhere near to what this infrastructure will create for the industry and for patients.”

Barrett expects that healthcare organizations will apply to become QHINs in the second quarter of 2022. By the third quarter, he thinks that the RCE will onboard some of these QHINs and start to operationalize them.

“This is going to be a real transitional year for a lot of these entities that want to become QHINs to better understand what they need to do and how they need to do it,” Barrett said.

For example, QHIN applicants will need a third-party certification or accreditation to demonstrate its level of rigor around privacy and cyber security.

Barrett said that as TEFCA begins to operationalize, healthcare organizations will be at a disadvantage if they do not join the network as a QHIN or participant.

For instance, patients will not be able to access their comprehensive health data from a healthcare organization that is not part of TEFCA, which may prompt them to change providers.

“These entities will have every opportunity to take advantage and provide these capabilities and services,” Barrett said. “The incentives from an economic perspective are pretty large.”